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Trial · Interventional

CompletedPhase 3Results postedRegistry data

A Study of Tirzepatide (LY3298176) in Participants With Type 2 Diabetes on Metformin With or Without Sulfonylurea (SURPASS-AP-Combo)

NCTNCT04093752 (opens ClinicalTrials.gov in a new tab)Other id17210Other idI8F-MC-GPHO

Overview

Status
Completed
Phase
Phase 3
Enrollment
917 participants (actual)
Sponsor
Eli Lilly and Company · Industry
Design
Randomized · Open label (no masking)
Countries
4 countries

Australia, China, India, South Korea

Start
9 Dec 2019
Primary completion
1 Nov 2021
Completion
24 Nov 2021
First posted
18 Sept 2019
Last update posted
6 Jan 2023
Conditions
Type 2 Diabetes

Timeline

1 trial · 1 completed · 1 with posted results

  • Completed
  • Ongoing
  • Not yet recruiting
  • Stopped
  • Estimated dates (est.)
  • Results posted
2019202020212022
  1. Ph 3

    A Study of Tirzepatide (LY3298176) in Participants With Type 2 Diabetes on Metformin With or Without Sulfonylurea (SURPASS-AP-Combo)

    NCT04093752

    9 Dec 2019 to 24 Nov 2021

Registry summary

Text and fields below are the sponsor's entries at ClinicalTrials.gov, shown as posted.

The main reason for this study is to compare the study drug tirzepatide to insulin glargine in participants with type 2 diabetes on metformin with or without a sulfonylurea.

Interventions

  • TirzepatideDrug
  • Insulin GlargineDrug

Arms4

  • Experimental

    5 mg Tirzepatide

    Participants received 5 milligrams (mg) tirzepatide administered subcutaneously (SC) once weekly (QW).

  • Experimental

    10 mg Tirzepatide

    Participants received 10 mg tirzepatide administered SC QW.

  • Experimental

    15 mg Tirzepatide

    Participants received 15 mg tirzepatide administered SC QW.

  • Active comparator

    Insulin Glargine

    Participants received insulin glargine administered once daily (QD) SC. The starting dose of insulin glargine was 6 Insulin Units (IU)/day at bedtime, titrated to a fasting blood glucose (FBG) between 72-100 milligrams per Deciliter (mg/dL), following a treat-to-target (TTT) algorithm.

Primary outcomes1

Outcomes the sponsor listed as primary.

  1. Mean Change From Baseline in Hemoglobin A1c (HbA1c) (10 mg and 15 mg)

    Time frame · Baseline, Week 40

    Registry description

    HbA1c is the glycosylated fraction of hemoglobin A. HbA1c is measured primarily to identify average plasma glucose concentration over prolonged periods of time. Least Squares (LS) mean was determined by mixed model repeated measures (MMRM) model with covariates Baseline + Country + Baseline Oral Antihyperglycemic Medication (OAM) Use (Metformin (Met), Met plus Sulfonylurea (SU)) + Treatment + Time + Treatment\*Time (Type III sum of squares).

Secondary outcomes(9)
  1. Mean Change From Baseline in HbA1c (5 mg)

    Time frame · Baseline, Week 40

    Registry description

    HbA1c is the glycosylated fraction of hemoglobin A. HbA1c is measured primarily to identify average plasma glucose concentration over prolonged periods of time. LS mean was determined by MMRM model with covariates Baseline + Country + Baseline OAM Use (Met, Met plus SU) + Treatment + Time + Treatment\*Time (Type III sum of squares).

  2. Mean Change From Baseline in Body Weight

    Time frame · Baseline, Week 40

    Registry description

    LS mean was determined by MMRM model with Baseline + Country + Baseline OAM Use (Met, Met plus SU) + Baseline HbA1c Group (\<= 8.5%, \>8.5%) + Treatment + Time + Treatment\*Time (Type III sum of squares) as covariates.

  3. Percentage of Participants Achieving an HbA1c Target Value of <7.0%

    Time frame · Week 40

    Registry description

    HbA1c is the glycosylated fraction of hemoglobin A. HbA1c is measured to identify average plasma glucose concentration over prolonged periods of time. Imputed data includes observed value and imputed value if endpoint measure is missing.

  4. Percentage of Participants Achieving an HbA1c Target Value of <5.7%

    Time frame · Week 40

    Registry description

    HbA1c is the glycosylated fraction of hemoglobin A. Imputed data includes observed value and imputed value if endpoint measure is missing.

  5. Mean Change From Baseline in Fasting Serum Glucose

    Time frame · Baseline, Week 40

    Registry description

    Fasting serum glucose (FSG) is a test to determine sugar levels in serum sample after an overnight fast. LS mean was determined by MMRM model with Baseline + Country + Baseline OAM Use (Met, Met plus SU) + Baseline HbA1c Group (\<= 8.5%, \>8.5%) + Treatment + Time + Treatment\*Time (Type III sum of squares) as covariates.

  6. Mean Change in Daily Glucose Average From Baseline in 7-Point Self-Monitored Blood Glucose (SMBG) Values

    Time frame · Baseline, Week 40

    Registry description

    The SMBG data was collected at the following 7 time points: Morning Premeal - Fasting, Morning 2-hour Post-meal, Midday Premeal, Midday 2-hour Post-meal, Evening Premeal, Evening 2-hour Post-meal and Bedtime. LS mean was determined by MMRM model with Baseline + Country + Baseline OAM Use (Met, Met plus SU) + Baseline HbA1c Group (\<= 8.5%, \>8.5%) + Treatment + Time + Treatment\*Time (Type III sum of squares) as covariates.

  7. Percentage of Participants Who Achieved Weight Loss ≥5%

    Time frame · Week 40

    Registry description

    Imputed data includes observed value and imputed value if endpoint measure is missing.

  8. Diabetes Treatment Satisfaction as Measured by the Diabetes Treatment Satisfaction Questionnaire, Change Version (DTSQc) Hyperglycemia, Hypoglycemia and Treatment Satisfaction Score

    Time frame · Baseline, Week 40

    Registry description

    DTSQc, an 8-item questionnaire, assesses relative change in treatment satisfaction perceived frequency of hyperglycemia, and perceived frequency of hypoglycemia from baseline to week 40 or early termination. The treatment satisfaction score ranges from -18 to 18 where the higher the score the greater the improvement in satisfaction with treatment. The lower the score the greater the deterioration in satisfaction with treatment. The hyperglycemia and hypoglycemia scores range from -3 to 3 where negative scores indicate fewer problems with blood glucose levels and positive scores indicate more problems than before. LS mean was determined by ANCOVA model for endpoint measures with Baseline + Country + Baseline HbA1c Group (\<=8.5%, \>8.5%) + Baseline OAM Use (Met, Met plus SU) + Treatment (Type III sum of squares) as covariates.

  9. Rate of Hypoglycemia With Blood Glucose < 54 mg/dL or Severe Hypoglycemia

    Time frame · Baseline through end of safety follow-up (Up To Week 44)

    Registry description

    The hypoglycemia events were defined by participant reported events with blood glucose \< 54 mg/dL \[\<3.0 Millimole per Liter (mmol/L)\] or severe hypoglycemia. Severe hypoglycemia is defined as an episode with severe cognitive impairment requiring the assistance of another person to actively administer carbohydrate, glucagon, or other resuscitative actions. These episodes may be associated with sufficient neuroglycopenia to induce seizure or coma. The rate of post-baseline hypoglycemia was estimated by negative binomial model: Number of episodes = Country + Baseline OAM Use (Met, Met plus SU) + Baseline HbA1c Group (\<= 8.5%, \>8.5%) + Treatment, with log (exposure in days/365.25) as an offset variable.

Posted results

Values are shown as posted at ClinicalTrials.gov, with their units. PepBank has not converted, pooled or compared them.

Primary outcome results

Primary outcomeLeast squares mean· Baseline, Week 40

Mean Change From Baseline in Hemoglobin A1c (HbA1c) (10 mg and 15 mg)

GroupValue (Percentage of HbA1c)Spread
10 mg Tirzepatide-2.440.073
15 mg Tirzepatide-2.490.072
Insulin Glargine-0.950.073
Secondary and other outcome results(7)
Secondary outcomeLeast squares mean· Baseline, Week 40

Mean Change From Baseline in HbA1c (5 mg)

GroupValue (Percentage of HbA1c)Spread
5 mg Tirzepatide-2.240.070
Insulin Glargine-0.950.073
Secondary outcomeLeast squares mean· Baseline, Week 40

Mean Change From Baseline in Body Weight

GroupValue (kilograms (kg))Spread
5 mg Tirzepatide-5.00.32
10 mg Tirzepatide-7.00.33
15 mg Tirzepatide-7.20.33
Insulin Glargine1.50.33
Secondary outcomeNumber· Week 40

Percentage of Participants Achieving an HbA1c Target Value of <7.0%

GroupValue (Percentage of participants)
5 mg Tirzepatide75.44
10 mg Tirzepatide86.04
15 mg Tirzepatide84.38
Insulin Glargine23.72
Secondary outcomeNumber· Week 40

Percentage of Participants Achieving an HbA1c Target Value of <5.7%

GroupValue (Percentage of participants)
5 mg Tirzepatide14.91
10 mg Tirzepatide20.72
15 mg Tirzepatide27.68
Insulin Glargine0.00
Secondary outcomeLeast squares mean· Baseline, Week 40

Mean Change From Baseline in Fasting Serum Glucose

GroupValue (milligrams per deciliter (mg/dL))Spread
5 mg Tirzepatide-58.62.13
10 mg Tirzepatide-66.22.19
15 mg Tirzepatide-64.82.19
Insulin Glargine-46.22.19
Secondary outcomeLeast squares mean· Baseline, Week 40

Mean Change in Daily Glucose Average From Baseline in 7-Point Self-Monitored Blood Glucose (SMBG) Values

GroupValue (milligrams per deciliter (mg/dL))Spread
5 mg Tirzepatide-77.02.09
10 mg Tirzepatide-83.42.16
15 mg Tirzepatide-84.62.18
Insulin Glargine-42.82.18
Secondary outcomeNumber· Week 40

Percentage of Participants Who Achieved Weight Loss ≥5%

GroupValue (Percentage of participants)
5 mg Tirzepatide55.70
10 mg Tirzepatide71.62
15 mg Tirzepatide74.11
Insulin Glargine5.58

Adverse events, as posted

Adverse events as posted: participants affected out of participants at risk, by group
GroupDeathsSerious eventsOther events
5 mg TirzepatideParticipants received 5 mg tirzepatide administered SC QW.0 / 23015 / 230174 / 230
10 mg TirzepatideParticipants received 10 mg tirzepatide administered SC QW.0 / 22814 / 228201 / 228
15 mg TirzepatideParticipants received 15 mg tirzepatide administered SC QW.1 / 22915 / 229193 / 229
Insulin GlargineParticipants received insulin glargine administered QD SC. The starting dose of insulin glargine was 6 IU/day at bedtime, titrated to a FBG between 72-100 mg/dL, following a TTT algorithm.2 / 22020 / 22083 / 220

Each cell reads participants affected / participants at risk, as the registry posted them.

Registry data comes from ClinicalTrials.gov. Study results come from studies, not from the registry. How PepBank works

Studies2

Studies that cite this trial.

Studies with results

1 study on this page

Indexing hint: Randomized controlled trial · 2023

13 results

Tirzepatide versus insulin glargine as second-line or third-line therapy in type 2 diabetes in the Asia-Pacific region: the SURPASS-AP-Combo trial.

Gao et al. 2023Nature medicinecited by 80

PMID 37231074DOI 10.1038/s41591-023-02344-1PUB-37231074

Rights unknown13 results

More studies

1 study on this page

PubMed tag: none · 2024

Efficacy and Safety of Tirzepatide in Patients with Type 2 Diabetes: Analysis of SURPASS-AP-Combo by Different Subgroups.

Bi et al. 2024Diabetes therapy : research, treatment and education of diabetes and related disorderscited by 6

PMID 38494574PMC11043231DOI 10.1007/s13300-024-01561-2PUB-38494574

Free to read · publisher termsCC BY-NC
Read at source

Eligibility

Who could join, as posted.

Sex
All
Age
from 18 Years
Healthy volunteers
Not accepted
Inclusion and exclusion criteria, as posted
Inclusion Criteria: * Type 2 diabetes mellitus * Treated with stable metformin with or without a sulfonylurea (metformin ≥1000 milligrams/day; sulfonylurea should be at least half the maximum dose) for at least 2 months * Are insulin-naive (except for the use of insulin for treatment of gestational diabetes or short-term use \[≤14 consecutive days\] for acute conditions) * HbA1c ≥7.5% to ≤11.0% at screening * Stable weight (±5%) ≥3 months, and agree to not initiate a diet and/or exercise program during the study with the intent of reducing body weight other than the lifestyle and dietary measures for diabetes treatment * Body mass Index (BMI) ≥23 kilograms per meter squared Exclusion Criteria: * Type 1 diabetes mellitus * Have history of chronic or acute pancreatitis * Have history of proliferative diabetic retinopathy; or diabetic maculopathy; or non-proliferative diabetic retinopathy that requires acute treatment * Have a history of severe hypoglycemia and/or hypoglycemia unawareness within the 6 months * Have a history of ketoacidosis or hyperosmolar state/coma * Have a known clinically significant gastric emptying abnormality, have undergone or plan to have during the course of the study, or chronically take drugs that directly affect GI motility * Have acute myocardial infarction (MI), stroke or hospitalization due to congestive heart failure (CHF) within 2 months * Have family or personal history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN-2) * Have been treated with prescription drugs that promote weight loss or similar other body weight loss medications including over the counter (OTC) within 3 months

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